3408 
y 1 



.EALTH OF SCHOOL CHIL- 
DREN. STATEMENT OF THE 
ENDEAVORS OF THE BOARD 
OF EDUCATION TO CON- 
SERVE THE HEALTH OF 
CHILDREN UNDER ITS CARE. 



LUTHER HALSEY GULICK, M.D. 

II 



NEW YORK 



Reprint from the Medical Record 
July 28, 1906 



WILLIAM WOOD & COMPANY 

NEW YORX 






HEALTH OF SCHOOL CHILDREN.* 

A STATEMENT OF THE ENDEAVORS OF THE BOARD 

OF EDUCATION TO CONSERVE THE HEALTH 

OF CHILDREN UNDER ITS CARE. 

By LUTHER HALSEY GULICK, M.D., 

NEW YORK. 
DIRECTOR OF PHYSICAL TRAINING, NEW YORK PUBLIC SCHOOLS. 

When one speaks of the schools of New York City, 
visions of great buildings containing thousands 
of children, situated in the congested parts of 
the city, come to mind. Public School 188, Man- 
hattan, down on the lower East Side, has on its 
register 4,363 pupils. Public School 84, Brooklyn, 
has on its register 4,805 pupils. These enormous 
schools, embracing numbers equivalent to the 
population of a fair-sized village community, form, 
however, only one phase of the picture. Public 
School 121, Brooklyn, last winter had on its regis- 
ter 36 pupils. The total number of principals, 
instructors, assistants, and the like was — one. 
Public School 7, Richmond, had 26 pupils on its 
roll; and in place of the 66 class-rooms in Public 
School 84, Brooklyn, it contained but one room, 
thus corresponding exactly to those village school 
buildings that have become so well known in the 
history of this country. 

In discussing the health of school children we 

*Read before the New York Academy of Medicine on 
May 24, 1906. 

Copyright, William Wood & Company 



are then discussing an enormously varied group 
of problems — those? ,of ? the single-room building 
in a sparsely settled territory, where the chil- 
dren live a considerable distance from the school ; 
and at the same time those of the great com- 
pact building situated in the most congested 
districts of the world, with narrow streets, high 
adjoining buildings, amid a population having the 
most varied national characteristics. 

Ventilation. — There has been appointed upon 
the Building Committee, which has charge of the 
erecting and the equipment of all new build- 
ings, a duly qualified medical man. Dr. Louis 
Haupt, thus insuring to this committee that expert 
counsel which is needed in all such work. 

All school buildings now being erected are being 
ventilated by the so-called "plenum" system. 
The air is forced into the room and finds its way 
out through special vents leading to the roof. 
Special hoods are installed to assist the flow and 
to prevent back draughts. The air is taken into 
the building at the level of the first or second 
stories, is carried through ducts to the cellar, there 
passes through a blower, and is carried into the 
class-room. It enters the class-room near the 
ceiling and is dispersed through all parts of the 
room by deflectors, finds its way finally to a 
vent near the floor, and is forced out by the in- 
coming air. The system is planned on the basis 
of furnishing 30 cubic feet of air to each pupil 
per minute, the basis of calculation being 50 
pupils to a room. Each room contains an average 
of 9,000 cubic feet, or 180 cubic feet per pupil. 

In view of the fact that there has been con- 
siderable criticism, not with reference to the 
theory of this plenum system, but with reference 
to the efficiency with which it was administered 



SEP 30 I9tt 



in the New York public schools, Dr. C. Ward 
Crampton, Assistant Director of Physical Train- 
ing, in cooperation with the Building Depart- 
ment, recently made a series of tests of 23 rooms in 
different buildings. I quote below part of Dr. 
Crampton's report. These rooms were selected, 
part of them in a direction toward the wind, part 
away from the wind; and in other respects as 
well the conditions sought were as varied as 
possible. I shall not burden you with a detailed 
report, but it was with great satisfaction that we 
discovered that the average income of air for 
these 23 rooms was 1,584 cubic feet per minute. 
This was not estimate, but careful measurement. 
"The air in the rooms, with but few exceptions, 
was rapidly changed in six or seven minutes. In 
those rooms where the air change was not com- 
plete, it was due to corners in which the air seemed 
to stagnate. This was the only evidence of failure 
in this system of ventilation. No pupils were 
seated in these corners." 

Heating. — "In the plenum system the air strikes 
first a series of steam pipes, known as 'tempering 
coils, ' which are only in use when the tempera- 
ture of the outside air is below 40°. These coils 
bring the air to this temperature. The air is then 
passed through two series of steam coils. The 
upper one is set at 70°, the lower one at 68°. 
When the temperature of the air in the duct enter- 
ing the class-room falls below 70°, the steam is 
automatically turned into the upper coil. Should 
it continue to fall below 68°, the steam is also 
turned into the lower coil. This is accomplished 
automatically by thermostats." 

Purity of Air. — "The Department of Buildings 
is now installing an entirely new feature which 
will insure not only purity of air, but the proper 



amount of humidity as well. There is to be placed 
in one of the new buildings an air washer or puri- 
fier. The air passes a tempering coil and is drawn 
through a chamber in which it is thoroughly sat- 
urated with water from spray jets. It is next 
passed through a series of baffle plates which reduces 
the water and leaves the air at the 50 per cent, 
humidity mark. The surfaces of these plates 
catch all the excess moisture, and with it are 
deposited all particles of dust and impurities. 
The air then passes through the heating system 
and is distributed through the building. This is 
a great advance, as it insures the cleanliness of the 
air supplied to the class-room. It appears to me 
that this system of ventilation now in use is most 
highly efficient in that it unquestionably furnishes 
each child with the requisite amount of pure air." 
Accommodations. — That there should be over 
70,000 children who can be only partially accom- 
modated in the schools in their vicinity seems in 
itself to be a condemnation of the Board of Edu- 
cation, particularly in view of the fact that this 
condition has now obtained with greater or lesser 
severity for a number of years. The reasons back 
of these conditions are not primarily financial, 
as they are supposed to be, but they are adminis- 
trative. For example, last year there moved out 
of the lower East Sijde of Manhattan 50,000 persons 
who went over to Brooklyn and settled in what 
is known as Brownsville. The school population 
of Brownsville at that time was 14,221. It was 
immediately increased by 3,123 — 22 per cent, in 
one year. This was one of the most seriously 
congested districts in the city before the flood of 
immigration came. It had at that time 6,323 
pupils on "part time." The increase raised the 
number on "part time "to 1 1 ,03 1 and increased the 



school population to 17,344. If this immigration 
had come to a district less seriously burdened, it 
would not have been so difficult to meet. The 
school accommodation, which was already in- 
adequate, was overwhelmed. Extensive plans 
were already under way to remedy the congestion. 
These have been extended and hastened. Five 
buildings, which will accommodate 10,150 children, 
are now under way. Six thousand sittings would 
give each child a seat ; but the Board are so sure of 
the continued growth of this district that they 
have not only allowed a leeway of 4,000, but have 
already had recommended by the Sites Committee 
three additional buildings. 

It usually takes thx^ee years after the need for 
increased school facilities has been demonstrated 
to discover the pi'oper site, to have this site ap- 
proved, the property condemned, plans drawn 
and approved, and. the building erected. The 
difficulty is not that the city is growing faster than 
it is possible to plan ahead for it, but that it is 
growing in unexpected ways, in unexpected places, 
and at unexpected times. There are now approx- 
imately enough sittings in Greater New York to 
accommodate all the children, but the location of 
the sittings does not correspond with the location 
of the children. A building with 1,000 seats can- 
not accommodate 1,000 children without ignoring 
their individual needs by dividing them into ten 
groups of exactly fifty each. 

Lighting. — The standard size of rooms being 
placed in new buildings is30X22Xi4 feet. The 
principle of unilateral lighting is regularly adopted, 
except in corner rooms. The so-called "H " build- 
ing permits of the location of the school in the 
middle of a block and affords to every room ade- 
quate light and area. This is a type of building 



which I understand was developed by Mr. Snyder, 
the Superintendent of Buildings. The amount of 
window space is never less than 20 per cent, of the 
floor area, nor more than 25 per cent. The top of 
the window is 13 feet 6 inches from the floor. The 
distance across the room is never over 22 feet, 
which is less than twice the height. 

Vision. — However perfectly the school building 
may be ventilated, with what degree of perfection 
light may be regulated and admitted, temperature 
controlled, humidity adjusted, the desk perfectly 
fitted to the individual; periods of sitting still short- 
ened, and periods of varied bodily and manual activ- 
ity lengthened — the central difficulty of school life 
remains. It is a difficulty which is dependent upon 
the fact that the treasures of civilization are stored 
in print — in minute black marks upon a white 
surface, which must be held relatively close to the 
eyes. This involves a conscious attention and 
strain of the ocular apparatus to which it was not 
adapted during the long ages when it was being de- 
veloped. Even under the most favorable con- 
ditions, the strain of civilization rests most heavily 
upon the child with reference not merely to the 
eye, but also to the nerve centers back of the eyes, 
and to that very great symptom-complex which is 
associated, as we have only recently discovered, 
with eyestrain. 

Examinations made in many cities and those 
made in New York under the direction of the 
Board of Health, have satisfied us that not less than 
30 per cent, of all children in our elementary 
schools are suffering from ocular defects demand- 
ing correction, and not less than 17 per cent, 
have ocular defects so severe as to be a serious 
menace to their progress. These defects acquire 
their significance, not because they are defects 



merely, but because they are defects of that 
portion of the human organism upon which 
learning and education largely rest. The relation 
of this condition to school work is shown by 
the fact that ocular defects are in direct ratio 
to the length of time the pupil has attended 
school. This is the point of strain, this is the 
point that demands more aggi-essive and constant 
safeguarding than any other of the systems of 
apparatus that we each possess. 

For diagnosis and treatment the Board of 
Education must depend upon the Board of Health. 
All that the Board of Education can do is to se- 
cure adequate lighting and suitable print, to pre- 
vent long consecutive use of short focus work, 
and to get the children to hold the book at a fair 
distance and at a right angle. 

Seating.— The largest sedentary class in the 
civilized world is probably that of public school 
children. The significance of this fact is fully 
realized when we remember that the ordinary 
effects of sedentary occupation are accentuated, 
because the individuals are growing rapidly. 
Hence the interference is not merely with function, 
but with growth as Vv^ell. The effects of badly- 
fitting school desks accentuate the manifest evils 
of sitting still. A desk which is too high, too 
low, or too far from the pupil may easily be the 
indirect agent for causing scoliosis, producing or 
aggravating myopia or astigmatism, interfering 
with the development of the legs through pressure 
upon the popliteal arteries, and the development 
of automatisms in the unconscious effort of the 
child to relieve the strained positions. 

There are two ways in which the_ Board of 
Education aims to combat the evils that are 
incident to sitting at school desks. The first of 



these is by minimizing the length of time that the 
child shall sit still, and the second by having 
a school desk as nearly related to the child who 
is to sit in it as is feasible. Every child in the 
elementary schools is required, at least twice 
in the morning and once in the afternoon, to take 
the so-called "setting-up exercise." This ex- 
ercise secures a large excursion of the diaphragm, 
thus accelerating abdominal circulation, increas- 
ing respiration and circulation in the arterial and 
venous system generally by the contraction of the 
large muscular masses of the back and legs. It 
also most forcibly extends the spine, calling 
attention to those parts of it which are bent forward 
chiefly in the sitting position, namely, the dorsal 
and cervical portions. 

The modern school differs from the school of a 
generation ago in no respect more markedly 
than with reference to its relation to the activity 
of the child. It seemed to be the earlier practice 
to regard the children as so many vessels that 
were to be filled with knowledge. The present 
situation is more accurately represented by the 
statement that the children are regarded as in- 
dividuals, who have powers that are to be de- 
veloped by specific activities of various kinds; 
and that these specific activities involve not 
merely action of the intellectual powers, but 
that they involve the activities of the hands, of the 
body, and of the vocal organs as well. The result 
is that instead of sitting still five hours per day, 
there is relatively little sitting still. A rather 
careful inquiry among the schools would indicate 
that in the lower grades less than 50 per cent, 
of the time is spent in sitting still, and that only 
in the last grades is more than three-fifths of the 
time spent in relatively motionless position, I 

8 



think, then, it is clear that if children do not sit 
still for any long, consecutive period and for 
not more than two hours out of the five, and that 
during the day they take exercises specifically de- 
signed to counteract the effect of a predominately 
sedentary occtipation — the problem is not as 
grave as it would be under the conditions of five 
hours of sitting still which obtained in the schools 
of a generation ago. 

With reference to the adaptation of the desk 
to the child there are very important things 
to be said. The Board of Education, after care- 
ful investigation, has selected forms of adjust- 
able school seats and desks, in order to give to 
children that which shall be best related to their 
needs. As a matter of fact, however, after the 
preliminary adjustment, these seats are rarely 
altered, for the following reasons: 

Pupils in high schools have no permanent seats, 
but go from room to room as they change subjects. 
Thus each pupil during the day will occupy 
four or five different seats. It is obvious that 
under such conditions it is neither necessary 
nor possible to have the seats adjusted to the 
individual pupil. All that can be done is to have 
the general grading of seats correspond to the 
general grading of the schools, and then to seat the 
tall children in the back of the room and the short 
children in the front. There is, however, in this 
administration, one obvious and thus far, unsolved 
difficulty. Children who are myopic or who are 
deaf in one or both ears, should be seated so that 
the disability will interfere with the progress as 
little as possible. If the case chances to be one 
of the tall pupils and the indications point to his 
being seated where the seats are low, the dif- 
ficulty is real. 



With reference to the elementary schools it 
must be explained that in the upper two years a 
large number of schools is organized on the so- 
called "departmental" basis, which means that 
the pupils go from room to room in pursuing the 
different subjects, exactly as pupils do in the high 
schools. The conditions that have just been de- 
scribed for the high schools apply, therefore, 
equally to these elementary schools organized on 
the departmental basis. This organization is pro- 
ceeding rapidly and bids fair to become general. 

Beginning now with the lowest grades in the kin- 
dergarten, we find small, solid chairs, which are 
designed to be moved into any part of the room 
where they are needed. These chairs are used by 
different pupils and at tables rather than at desks, 
as the floor must be cleared for the games that 
occupy such a large fraction of time in the kinder- 
garten. 

In the classes above the kindergarten and below 
the departmental grades, we find the following 
fact: In 70,000 cases the pupil is able to come to 
school but part of the day. This is because of 
congestion. These are the so-called "part time" 
classes. Two pupils each day occupy the same 
desk. The only adjustment possible in such cases 
is the general one and of having in each room such 
an assortment of such sizes of furniture as will suit 
the average class. The classes are promoted twice 
each year, but the changes of individual children 
from room to room and from school to school are 
so great as to constitute a serious diffictilty in the 
wa}'' of adjustment of school furniture to the in- 
dividual, even in those schools where there are no 
"part time" classes. 

The adjustment of the seat and desk to the in- 
dividual pupil involves the following measurements 

10 



of the child: Height of knee, in order that the seat 
may be adjusted; and height of elbow when the 
child is properly seated, for the adjustment of the 
desk. If the desk is adjustable front and back, 
as it should be, an additional measurement is 
needed in order to adjust the desk to the proper 
distance. I have indicated merely the most funda- 
mental measurements. 

To secure these measurements for the 600,000 
children of New York City schools is at the present 
time impossible. In our large schools are from 
1,000 to 5,000 pupils. The adjustment of each 
desk to fit in several respects the measurements 
of these numbers of children presents a problem 
in administration which has not been solved. It 
would involve the special employment of a con- 
siderable force of persons. I believe the time will 
come when with the cooperation of the Board of 
Health it will be possible to do far better than is 
now being done in the adjustment of furniture to 
the individual; but in view of the conditions of 
relatively brief sitting periods and many periods 
of muscular activity, I believe that there are other 
and more pressing problems with reference to 
school health than that of the adjustment of school 
furniture. 

Scoliosis. — Recognizing that the constant carry- 
ing of a weight on one side of the body is one of the 
predisposing causes toward scoliosis, particularly 
in girls of weak musculatiire, I had the weights of 
books carried home by children examined in a large 
number of schools. The facts with reference to 
the seventh year, dealing with girls approximately 
thirteen years of age, may be taken as a fair 
sample. From observations made of this class in 
forty-five schools it was found that the number of 
books carried on the average was 4.7, and that the 



average weight was 51-8 pounds. The books 
were carried on the left arm by 6g per cent, of the 
pupils. The reasons for carrying books about are : 
first, some of the books are needed for home study; 
secondly, as many of the schools are used in the 
evenings by other pupils, the desks must be left 
empty; thirdly, and very prominently, the pride 
of many girls who like to go on the streets with a 
large number of books so as to appear to be in a 
high grade. One report noted a child who had 
carried twenty-one blank pads to swell the total. 
It is our endeavor, which endeavor is being fur- 
thered by a large number of principals and teachers, 
to induce the children to carry these books alter- 
nately on the right and on the left arm. 

It should also be noted in this connection that 
the chief aim of physical training in the schools is 
to secure a good posture and particularly vigor 
of the muscles that support the spine and hold it 
erect. We have thus eliminated pretty largely 
muscular weakness and habitually bad posture as 
factors in the direction of scoliosis in the children 
of the New York City public schools. 

Over-SUidy. — In view of the normal activity of 
children, there is no danger, so far as school work 
is concerned, that they will do work involving too 
great activity. The danger is that the work will 
be too one-sided intellectually. If we analyze the 
school work for the first year, we discover that out 
of the total 25 hours per week, which are available 
between nine in the morning and three in the after- 
noon on the five school days, i^ hours are given 
to opening exercises, 7^ hours are given to physical 
training, talks on cleanliness, and the like, games 
and recesses, i 2-3 hoiurs to penmanship, i^ hours to 
nature study, 2 hours to drawing and constructive 
work, h hour to weaving with cord and raffia, i hour 



to sewing. A total of 15 hours and 25 minutes, 
or 62 per cent, of all the time, is thus given to work 
which is nearly all of it such as to involve muscular 
activity, none of it involving study. It is needless 
to say that no home work is demanded of these 
little children. The total amount of time per week 
given to English is 7^ hours, and to mathematics 
2 hours and 5 minutes, making a total of 9 hours 
and 35 minutes per week, or a little under two hours 
per day. Two hours per day judiciously inter- 
spersed with recesses, games, gymnastics, hand 
work, drawing, and music, is not an excessive 
burden. 

Turning now to the fourth year, during which 
the children are about ten years of age, we find 
i^ hours given to opening exercises, 2^ hours to 
physical training, recesses and organized games; 
i^ hours to penmanship, i^ hours to nature study, 
2 hours to drawing and constructive work, i 
hour to sewing, i hour to music, making a total 
of lo^ hours, o 4 1 per cent. The Board of 
Superintendents recommends to parents that the 
children be not allowed to study over an hour 
per day outside of school on this work. Thus 
we have, during the day four hours spent on in- 
tellectual tasks, broken up into short periods by 
physical training, manual training, music, reces- 
ses, and with less than one hour of home study. 
This does not seem to me to be either in theory 
or in practice excessive. 

With reference to the eighth year, where the 
pressure is said to be the worst, we find i^ hours 
spent in opening exercises, i^ hours in physical 
training or games, i hour and 20 minutes given 
to drawing and constructive work, i hour to 
music, I hour and 20 ininutes of science work, 
which is, to a considerable extent, done with 

13 



apparatus, so that it should be classed with the 
more organic subjects. This gives a total of 6 
hours per week. It leaves 3 hours and 48 minutes 
per day given to intellectual tasks. No period is 
longer than 40 minutes. The amount of home 
study is by request of the Superintendent of Schools 
to be limited to an hour and a half per day. 

In view of these facts, how are we to account 
for the other facts that children are frequently 
overworked and that the number of nervous and 
fatigued children is considerable? There are 
several other factors in the case. I have not dis- 
cussed the problem of overwork in the high schools, 
because they include such a small factor of the 
total number of pupils. I believe, however, that 
the conditions in the high schools are not as 
favorable with reference to overwork as they 
are in the elementary schools. It is unfair to 
charge up to the Department of Education all the 
evils that result from very short nights, after- 
school work of an economic character, mal- 
nutrition, and the effects of tenement housing. 

1, It is true that many children are nervous 
and ambitious to a far greater extent than are 
other children, and that the amount of pressure 
which it is necessary to bring to bear upon average 
children to secure from them normal and reason- 
able work, tends to produce overexertion on the 
part of the more sensitive ones. This will account 
for the strenuous life of many ambitious girls 
and a few boys. 

2 . There is a considerable number of cases where 
overwork is to be accounted for on the ground of ex- 
cessive expenditure of energy in other directions 
than that of school life. There are many chil- 
dren who have not yet reached adolescence whose 
hours of sleep are totally uncontrolled, who are 

14 



usually out late in the evening. Upon such chil- 
dren the bui-cienof school life does rest too heavily, 
because they do not have the needed recuperation. 

3. A most unfortunate class consists of those 
who are obliged to work either early or late to help 
toward their own support or that of the family. 

The present course of study is adapted neither 
to the very bright nor to the exceedingly slow. 
It is inevitable, therefore, that the bright shall 
find it at times tending to mind wandering, be- 
cause it is too easy; and the exceedingly slow 
shall find it pressing upon them with undue severity. 
For these reasons it has been made increasingly 
easy for children to "skip" grades. The com- 
plete remedy for both of these cases would be 
to have so few children in each class that there could 
be a very high degree of personal acquaintance 
and individual treatment. The difficulties in the 
way of this will be discussed in another section. 

Malnutrition. — -We must all agree that it is 
fundamental to the welfare of the state that chil- 
dren shall be well-nourished during the growing 
period. There is little of any value in the world, 
in any permanent way, unless children grow up 
healthy and vigorous. Our science, art, literature, 
and religion will not only sink into relative ob- 
scurity, but they have in themselves no possible 
good except upon the basis of the life of those 
which they are to serve. With this general 
truth (which no doubt will be differently stated 
by different people) we must all agree. 

But in a rapidly-developing state, a state in 
which every decade presents problems which are 
both fundamental and new, there exist in 
evitably, confusion and lack of agreement with 
reference to that particular arm of the State 
which shall look to and provide for the various 

IS 



needs of the community. The Department of 
Education has developed gradually, out of the 
needs of pauper children. It is no longer a 
charity but is patronized by the great majority 
of our citizens. The Board of Health arose out 
of the need of corporate action with reference to the 
spread of contagious diseases. 

Many children in this community are underfed. 
Many more are badly fed, with equally injurious 
results. Does this problem belong to the Board of 
Health or to the Board of Education? It is a 
matter that relates to health and yet education is 
frtiitless except upon the basis of good nutrition. 
The British Parliament is apparently about to 
authorize the supplying of meals to young children — 
a plan that has already been adopted in Paris and 
a number of other European cities. This is one of 
the problems that has not been attacked by either 
the Board of Health or by the Board of Education 
in New York City. It is nevertheless a fundamental 
one — ^and I believe, a prominent one — so long as 
poverty and ignorance shall continue. It de- 
mands solution. The solution may be carried out 
by the Board of Education, but ultimately it is 
a medical question — not an educational question. 
The authoritative word and public opinion both are 
to be made through the medical men of this city. 
I believe the time will come when all school chil- 
dren will be offered an adequate lunch, furnished 
by the Board of Education. There must needs 
be, however, a large amount of public education 
before this can be accomplished. 

Feehle-Minded Children. — During the past few 
years it has slowly developed in this city, as in 
other cities, that there is a small percentage of 
children — from one-half of one to two per cent. — 
so below grade mentally as to be incapable of the 

i6 



most profitable education in classes with average 
children. It is further recognized that one of the 
fundamental difficulties with reference to these 
unfortunates in many cases is malnutrition. Ac- 
cordingly, the Board of Education has employed a 
specialist, Dr. Elias G. Brown, who spends his 
whole time in examining those whom principals 
and teachers think may be in such condition as to 
profit most by the special classes provided for 
these cases. He advises with reference to the care 
of such children and counsels with reference to 
their condition. This is recognized to be but a 
first step in a much larger plan. The success of 
treating these children in special classes, by 
methods in which manual work, physical work, 
baths, and the like are made prominent, has been 
such as to warrant extension of the work to include 
other classes of cases. 

Defective Children. — The Board of Education 
last winter, on the recommendation of the Super- 
intendent of Schools, Dr. William H. Maxwell, has 
taken up the consideration of care for the blind, 
the deaf, and those who are crippled. It is not too 
much to say that provision in special classes and 
special institutions will be made for these cases 
as rapidly as is possible. Hasty movement, how- 
ever, in the face of so complex a set of problems is, 
of course, impossible. Each special class must be 
approached tentatively and methods of work best 
adapted to a public school s^'stem under American 
conditions must be slowl}^ elaborated. 

Physical Training. — The amount of time that can 
be spent for physical training in the different grades 
is as follows (time schedule on the basis of 1,500 
minutes per week) : 
Years I II III IV V VI VII VIII 

450 165 165 150 90 90 90 90 minutes 

17 



During these comparatively few moments it is 
obviously impossible to attempt even to give each 
pupil that general physical exercise which all 
children need. That is, it is not possible during 
the school day to undertake that general physical 
training which belongs to the playground, to the 
athletic field, or to the home. Neither is it possible, 
in this brief time, to give the pupil all the recre- 
ation that is needed. The first and most important 
aim of our school gymnastics is to counteract the 
effect of the school desk. 

The partially flexed spinal column allowing the 
sternum to approximate closer to the vertebrae 
than normal, which allows the muscular layers of 
the abdominal wall, as well as the supporting 
members of the abdominal viscera to relax, results 
in a train of evils which is perfectly familiar to all 
since the classic work of Glenard, "Le Ptosis 
General." A decreased portal circulation, lessened 
intestinal peristalsis, a lower blood pressure, a 
shallower breathing — a familiar symptom-complex 
— these symptoms are more marked in a growing 
child than in adults whose muscles and bones have 
already acquired full development. It is not wise 
to give exercises that shall induce perspiration, 
for change of clothing is not possible and the child 
must continue in his school work immediately after 
the exercises. Nor ,is it possible to give exercises 
that shall involve a large amount of noise. In the 
great majority of cases the pupils must take their 
exercises in the class-room. Eighty-three of the 
five hundred buildings possess gymnasiums, which 
renders the problem somewhat easier. 

The first and most direct means taken to meet 
these conditions is what we call our "Two Minute 
Exercise." In it there is emphasis upon forced 
deep breathing, with its effect upon portal circu- 

i8 



lation through the influence of the alternate con- 
traction and relaxation of the diaphragm. Vigor- 
ous work is given to the extensors of the spine. 
This is in order to counteract the constant stretch- 
ing that occurs when one bends the back forward. 
These exercises also call into play the large mus- 
cles surrounding the shoulder and the hip joints, 
as well as the extensors of the leg. Thus the large 
muscle masses of the body are exercised, the cir- 
culation thereby quickened, and the consumption 
of oxygen increased. These exercises are given at 
the end of each hour in the morning and between 
the two hotirs in the afternoon. The windows are 
opened during the exercises. Thus it is that where 
the S3^stem is fully carried out, a pupil never sits 
two consecutive hours without there intervening 
this group of exercises. 

The second measure which is taken to combat 
the effects of the school desk, is the formal ph3^s- 
ical training. This consists of a series of ex- 
ercises, the chief emphasis of which is placed 
upon movements of the large muscular masses 
lather than upon delicate and complicated move- 
ments of small muscular groups. The effects 
sought are primarily physiological. These ex- 
ercises are not designed to take the place of play, 
nor to furnish the general exercises that the pupil 
needs. They are designed to combat the effects 
of the school desk, to secure to each pupil good 
carriage, and erect and vigorous habits of walk- 
ing. 

In the schools having g}''mnasiums it is possible 
to use the lighter forms of apparatus, such as 
dumb bells, wands, Indian clubs, and the like. 
In other schools free exercises only can be used. 
In both cases there are prescribed and taught 
by the teachers series of exercises which demand 

19 



increasing muscular strength, endurance, and 
control from grade to grade. In addition to 
these formal gyinnastic exercises, it is possible 
in the lower grades to have a considerable number 
of vigorous gymnastic games, having for their 
purpose general recreation and physical training, 
which in the upper years must be carried on out- 
side of school hours. 

With reference now to the after-school ac- 
tivities, in the line of athletics, for our public 
school boys and girls: This work must, in the 
nature of the case, be voluntary. It cannot be 
carried on officially by the Board of Education, for 
this Board is not related to the out-of-school 
activities of children. There has, therefore, come 
into existence a great organization, known as the 
"Public Schools Athletic League." This League 
has on its board of directors the President of the 
Board of Education, the Superintendent of Schools, 
district superintendents, high and elementary 
school principals, class teachers, business men 
in the community, and others who are especially 
competent and interested in the problems of 
athletics for boys and girls. 

The first endeavor of this Athletic League was 
in the direction of establishing great sets of city 
games of the ordinary kind: running, jumping, 
relay racing, etc. , We clearly understand that 
these conventional athletics suffice merely to 
bring into prominence those boys who need ath- 
letic training the least; that is, those who are by 
inheritance and test endowed in physique and 
stamina. 

Fashion and wont are such great elements 
among boys as well as adults that this seems to be 
the most useful way of teaching the athletic 
spirit, cultivating school loyalty, and the like 



These great city games constitute the dramatic 
elements that appear in the public press and 
which are talked about by the boys. They do not, 
however, represent the chief work of the League, 
nor its main interests. Its main interests and its 
largest activities are to get boys having average 
or below average attainment, into vigorous ath- 
letic sports. The devices that are used for this 
purpose are, in the nature of the case, experimental 
and original. I mention but one: it is called 
"class athletics." We are giving trophies to the 
class in the borough of a given grade that can run 
the fastest for a short distance, or that can jump 
the farthest. Every member of the class is timed 
in his running or measured in his jumping, and an 
average is struck. This is compared with the 
average for other classes. There is much interest 
in this. The boys who are most expert help the 
boys who are less expert, because the average is 
influenced even more by the inferior runners 
than by the superior ones. 

The problem of athletic sports for girls we are 
just now seriousty attacking. There is now a 
public wave of interest in athletics for girls and 
women. This interest has already, in many cases, 
led girls and women to overdo. They have not had 
preliminary athletic experience, nor are they 
physiologically competent to wisely undertake 
athletics of as strenuous a character as those 
which are provided for bo^^s and men. Our 
first object, then, is to exercise a controlling in- 
fluence with reference to these sports, to see 
that they are not overdone and that unprepared 
individuals are kept out of them altogether. 
We aim also to devise new sports and to modify 
old ones, so that they shall be as adapted to the 
development of girls as the present forms of ath- 
letics are to boys. 

21 



The Board of Education is conducting two forms 
of after-school activity which are closely related 
to the health of its children. One is known 
as the Evening Recreation Centers, and the other 
as the Afternoon and Evening Playgrounds 
During the year 1 904-1 905, in the most congested 
parts of the cit5^ 21 schools were opened in the 
evening as recreation centers. In these schools 
ample opportunities were afforded for games, 
dancing, gymnastics, as well as the more quiet 
forms of recreation. The average attendance 
at these 21 recreation centers was 7,276 per 
evening. Some of the recreation centers were 
equipped with shower baths. The average number 
of persons taking baths per evening was 148. 
During the summer, after the close of the regular 
schools, the Board of Education opens a large 
number of gymnasiums and playgrounds in the 
afternoon. Last summer there were in operation 
67 of such playgrounds. Regular gymnastic work 
and plays and games of many kinds, under expert 
supervision, are carried on in this way. The 
average attendance last year was 38,566 per day. 
During the evenings 11 of the schools having 
suitably equipped roofs, opened these roofs to the 
public, provided bands, and supplied expert 
supervision. The average attendance at these 11 
roofs was 32,148. The 7 schools having bath 
equipments during last summer gave a total 
of 288,387 baths. The average per day is not 
recorded. 

Instruction in Physiology and Hygiene. — In pass- 
ing, mere reference can be made to this subject. 
It would demand a whole paper to acquaint you 
with any degree of fairness with the respects 
in which this work is being done. 

Instruction is given as to the effects of alcohol 



and narcotics, in accordance with the law of the 
State. In doing this, particular pains are taken to 
emphasize the constructive phases of the subject — 
not to elaborate upon pathology or to depict patho- 
logical conditions. The case against the general 
consumption of alcohol is sufficient!)'- great, so that 
it is found to be wholly unnecessary to resort to any 
extreme statements in order to carry out the provi- 
sions of the law. 

A single point of view is taken each year rather 
than the mere repetition of the subject matter with 
greater detail year after year. For example, in the 
fourth year there is the general topic of good health; 
the fifth year, what children may do in the emergen- 
cies in which they may find themselves ; the sixth 
year, health from the standpoint of the dweller in 
towns, contagious diseases, water supply, and the 
like. In the seventh year we find the usual 
physiolog}^ and hygiene. In the eighth year the 
questions of personal habits, personal control, 
and the like are discussed, as well as to some ex- 
tent the nervous system and the special senses. 

Ideals. — It may not be out of place to indicate 
some ideals toward which additional progress 
should be made with reference to the health of 
school children. 

I. There should be individual care, personal in- 
quiry and knowledge of the home life of ap- 
proximately the lower tenth of every class. This 
includes those who, for one reason or another, twice 
fail of promotion. This work is now being done 
to some extent by the school nurses, under the 
employ of the Board of Health. The work should 
be very greatly extended. Allowing that there 
are but 500,000 children, of which but 50,000 need 
this individual attention, and that each school 
nurse can wisely handle 100 such cases, keeping 



in personal touch with them and with their families, 
it would take 500 nurses. These 500 nurses 
would add to the wealth of the State by saving 
to efficient lives a large fraction of those who now 
come to adult life with such a degree of impaired 
vigor or defective development as to be relatively 
unproductive in an economic sense. Whatever 
is necessary to be done to prevent incompetence 
must be done. This can only be accomplished by 
personal attention of a consecutive character by a 
person who is qualified from the standpoint of 
health, in cooperation with a physician. 

2. We need to have the consecutive records 
of all children as to age, height, weight, eye, ear, 
nose, throat, heart, lungs, and so on. Only 
in this way can the highest degree of efficiency 
be secured. I was much interested recently 
to see in the current press accounts of medical 
care of certain child laborers in India. This care 
was given most efficiently, not from the stand- 
point of humanitarian interests, but because it was 
discovered that the working capacity of the 
children was a direct function of their health, 
and that it paid financially to keep them well. 
It will pay well educationally for us to keep track 
of the children with reference to these matters 
of health. It is a relative waste of money to en- 
deavor to train the nervous system of a child 
that is seriously undernourished, whose growth 
is perverted, and who has reflex irritation from 
defective teeth, eyes, and so on. This work 
which is being undertaken in such a vigorous way 
by the Board of Health, must be extended and 
coordinated more perfectly with the Board of 
Education. 

3. The size of classes should be decreased, so that 
the nervous strain upon teachers shall be lessened ; 

24 



so that there shall be opportunity for a larger 
degree of individual attention than now obtains; 
so that teachers may be able to become per- 
sonally acquainted with the children and to some 
extent have regard for their health in a way that 
is not possible in classes of fifty or sixt3^ where 
each one must be pressed into certain objective 
standards. 

4. London has a minimum requirement of 
30 square feet of playground space for each child 
in connection with the schools. This is very 
little. New York should do no less, and yet for 
a large school — for Public School 188, in which 
there are approximately 5,000 children — it would 
take 150,000 square feet, or a square of 130 yards 
on the side. An average city block up-town 
is 200 feet wide and 600 feet long. It would take 
a block 50 feet wide and 300 feet long to provide 
the needed area for this one school. 

5. There should be an open-air playground 
within walking distance of each child. What is 
walking distance for a child three years old needs 
to be very near. Places where older boys may 
play ball need not be so close together. 

6. Special classes and schools should be or- 
ganized for defective children of all kinds. It 
matters not if these are crippled because of dis- 
ability of the osseous system, the ocular, the 
auditory, or from central lack of development. 
The demands both of humanity and of social 
economy involve the care of these unfortunates 
by the public schools. 

In making progress such as is here suggested, 
two fundamental factors are involved: first, an 
agreement as to what ought to be done ; and second, 
the power to do. Concerning the wisdom of most 
of these steps the medical and educational men 

25 



of the world are pretty well agreed, but the power 
is not yet present. Institutions like the public 
schools cannot proceed very much in advance of 
public sentiment, particularly when such advance 
involves the expenditure of large amounts of money. 
To furnish 500 school nurses together with such 
organization, supplies, and the like as they would 
need, would involve the annual expenditure of 
upwards of $500,000. To secure the consecutive 
examination of all children, as is recommended, 
would involve the employment for the city, I 
should estimate, of not less than 250 medical ex- 
aminers. The present property value of the public 
schools is not less than $150,000,000. To add to 
this so that each child could be in a class not to 
exceed thirty children, would involve the ex- 
penditure of an additional 60 per cent., or $90,000,- 
000. The additional teaching and supervisory 
force would cost about $15,000,000 per annum 
more than the $25,000,000 now spent. To furnish 
for each school thirty square feet of playground 
space would cost many more millions; how many 
it would be difficult to estimate. To furnish a 
playground within walking distance of each child 
in the congested districts is not possible on the 
present basis. If each child below Fourteenth 
Street were to be given a space three yards square, it 
would demand - that approximately every fifth 
building should be torn down in that area. The 
development of many-storied playgrounds seems 
to me to be inevitable. The development of special 
classes and schools for all defectives would be an 
exceedingly large enterprise. 

The most serious obstacle in the progress of such 
a program as I have outlined is the lack of informed 
public opinion as to the necessity for these things. 
Our city possesses the money and is inclined to 

26 



deal very generously with all matters affecting 
the health and welfare of children. But the parents 
of most of these children were brought up under 
conditions of either relativel}^ little school life, or 
of school life on the old basis of the three " R's " and 
under conditions where a considerable degree of 
that general motor education which goes with 
domestic work and cooperation of boys with the 
parents was possible. These citizens probably 
fail to realize that the conditions have changed 
completeh' ; that it is no longer possible for children 
in central parts of New York City to play out of 
doors, as they themselves did, or to secure that 
muscular training and that motor education in 
connection with domestic work or cooperation 
with the fathers in their work which they them- 
selves secured; and further, that these functions 
must be discharged with reference to the children 
by the State through the public schools, because 
under the conditions named the home no longer 
serves the need of the children in these respects. 
What we need, then, is education of public opinion. 
The most capable body for the formation of 
opinion with reference to the health of school 
children and with reference to specific steps that 
need to be taken in order to wisely meet the con- 
ditions of child-life as presented by the city, is the 
distinguished professional body, members of which 
I have the privilege of addressing this evening. 
Progress is being made in every one of the direc- 
tions that I have named. The Board of Edu- 
cation is not merely interested, but regards the 
health of school children as fundamental — as more 
fundamental than education — and recognizes its 
own responsibility with reference to these things; 
but under present conditions of public opinion it 
cannot proceed materially faster than it is now 

27 



going. Great strides have been made during the 
last decade. In fact, nearly all that is being done 
with reference to the health of the children has 
been developed during this decade. All that has 
been outlined can be carried out as soon as it is 
possible to procure the funds. The physicians of 
this community are in a position to speak authori- 
tatively with reference to these things, as no other 
persons can speak. They can enable the Board 
of Education to do these things. Without their 
help the Board of Education must proceed slowly 
and lamely in these matters. 

During the winter of 1905 there was an extended 
attack on the Board of Education because it used 
physical training, manual training, drawing, music, 
cooking — all those subjects that involve the training 
of the body, the training of the eye and the hand, 
the training of the breathing apparatus, the vocal 
apparatus — all of them involving central co- 
ordinations, motor images, and the like. That 
was a time when the Board of Education needed 
the support of the medical men of this city. Such 
support was not given. The Board of Education 
needs and craves not only the advice, but also and 
equally the support for every step which it takes 
with reference to increasing the health, the per- 
sonal efficiency, and the power to live of these com- 
plex groups of children that come to it from all 
over the world. For these reasons it was itwh 
peculiar pleasure and gratification that I received 
the kind invitation which has made the presenta-. 
tion of this paper possible. 



28 



LIBRARY OF CONGRESS 




